How Did You Handle Your Diabetes Diagnosis?

This is a question I receive in emails almost every month and I have my answer that I copy and paste in a return email. I will share it now.


First, I let people know that I was in the hospital when I received my diagnosis. I had been operated on to balloon out several arteries and had a stent implanted in one artery. As such, I had no room to become angry about the diagnosis. All I could do was let the nurses do their injections of insulin and follow their instructions if I was not able to eat enough, which was quite often.


When I was awake the first day, the hospital diabetes educator came around and introduced me to the testing supplies and how to test. She only had the equipment that my insurance would cover and of course told me that I would be given prescriptions for everything when I was discharged from the hospital. Since all the pharmacies would be closed when I was to be discharged, I was able to have her obtain my test strips and oral medications that the doctor had prescribed. She was very polite and took time to explain what the two medications were and how they would work for me.


What she all but ordered me to eat was whole grain foods and very lean meats (low fat of course). Little did I know then what problems this would cause. My son was able to come home to be able to transport me from the hospital. The next day I was able to fill the rest of my prescriptions. I was very fortunate that my pharmacist was watching my prescriptions and even then told me not to use the alcohol pads for cleaning my fingers. She said I should keep some around for times when I could not wash my hands, but that would always be the best to prevent cracked skin and very painful blood glucose testing. Since this was late October, I followed her directions.


Since I was still working, I did take the extra test strips at my expense. The pharmacist also showed me where to test on the sides of my fingers and explained that there was less nerves so I would have less pain. The pharmacist also suggested that I set up a log to track my blood glucose readings and the time. She also asked if a food log had been explained to me and I said no. She asked if I had a scale. I told her about my scale which could weigh in grams and ounces, could be zeroed for the container (called tare weight) and she commented that with that I was ahead of the game. She was becoming busy then and told me to write down questions and come back another day. She concluded that if she had time she would answer them for me then, or take them and answer them for me and I could pick them up another day.


Since my son had to get back to his work and schooling, he left the following day leaving me to my own devices. A couple of days later, I drove to the health food store and I needed a refill of my daily multivitamin. Since I knew the owner and knew that she had diabetes, I felt she would be able to answer a few questions. She did ask which medications I was taking and wondered why I had not been given one of the sulfonylureas. I said I was allergic to them so she moved on to research them. I told her I was not looking for a natural medication.


She said that she did not know of any that would help diabetes as she had tried several after her diagnosis and had only received short time help. She explained that once her body replenished what she was short of, the effects stopped. She did write down what to research myself and the tests to ask the doctor to do, to see if I was in the normal or low range. Then we talked about nutrition and the fact that I should reduce the number of carbohydrates and whole grains to get better results with the medications I was taking.


Her advice brought me out of the upper 200's to the upper 100's for blood glucose readings even though I kept reducing the number of grams of carbohydrates. So the next appointment in January the doctor and I had a good discussion about insulin. Since I had been researching it, he set me up with another doctor to establish the starting dosage for each insulin and she told me how to adjust (titrate) the amount of insulin based on my blood glucose readings for a correction and the number of carbohydrates I would be eating for that meal. She covered the readings I should be trying for and that it could take some time to get there.


She also covered hypoglycemia and having glucose tablets available for use. Then she started handing me sheet upon sheet covering the symptoms of hypoglycemia, hyperglycemia, and getting my baseline eye examination, dental examination, and set me up for a follow-up appointment with her and my primary doctor for making further corrections. With this I was off and running and managing my diabetes. Instead of A1c's in the upper 7's, my next was just above 6.0%.


I soon discovered that all the goals were what the American Diabetes Association recommended and further discussions with the owner of the health food store and my pharmacist taught me that it was better to set goals less that the ADA recommendations. I was reading Gretchen Becker's book The First Year - Type 2 Diabetes by then and I had found the website for David Mendosa.


Over the next few years, I did a lot of reading and researching on the internet. I had my first denial about three years after diagnosis and a bout of minor depression about the same time. Like most people, I have made bad mistakes, but I am happy to say that I have learned by making these mistakes.

Will Your Family Accept the Diagnosis of Your Diabetes?

The following is the topic for this blog. Will your family accept the diagnosis of your diabetes?

This is one of those topics where it is hard to say this applies or that applies. And it certainly is not one where you can even consider a one-size-fits-all solution. Every family is different and has their own unique family values. In this blog are two such cases and the resulting depression. The dynamics within a family can bring about various actions, some of which are not always pleasant or even desired.

Another family had this happen. The wife had a diagnosis of diabetes and except for her husband, kept this away from the rest of the family. Since the three children were all teenagers, they were not told. The last child had just graduated from high school and was home alone one day when the diabetes clinic called to remind the mother of her appointment the next morning. When the parents arrived home, all three were present and not in a good mood. The first question from one of the children was when she was going to have her legs amputated.

The husband spoke up and said that they would be going with their mother the next day to the appointment and that they could ask their questions then. There was a lot of grumbling, but every time they tried to ask a question, they were told to write them down and ask them the following morning.

The appointment the next morning was very tense as the three children asked question after question and the doctor carefully answered each one with the amputation question given its time. The doctor asked where they had heard this and the youngest daughter said one of her friend's father had his leg amputated. The doctor explained that it was always possible, but very seldom happened to people like their mother who was managing her diabetes very well. He then took time to show them a couple of pictures of sores that caused this to happen. He asked them if they saw anything that looked like these on their mother's legs. He then showed a picture of a foot ulcer and had them look at the bottoms of her feet.

The doctor then told them that in the six years their mother had diabetes, she was having no problems with either. At that statement, the three children sputtered – six years? Their father said that was right and the reason they had been kept in the dark was exactly the reason they were not putting up with the questions that had been raised. They had arranged the call the previous day to have them present at the appointment to have their questions answered.

The doctor answered a few other questions about diabetes and it effects on the body and he said as long as their mother continued to manage her diabetes as well as she had, she would be unlikely to have any of the complications. He informed the children that their mother was managing her diabetes without medications and had been since a few months after her diagnosis. He explained that with the meal plan she was following and the exercise plan she and their father were using, she should be able to stay off medications for many years. He said that could not be promised, but he could say that it was a good chance with the management practiced by their mother.

Then he introduced the CDE and said they would have another hour to ask questions of her. He emphasized that they were being told now and that they were at an age where they should understand and not listen to their friends and what they were being told by them. He concluded by saying that if they used the next hour wisely, they should learn a lot more about diabetes. If afterward, they had more questions he would answer the questions if they would write then down and either drop them by the office, send them in with their parents, or mail them.

As they left the office, they started asking more questions and the CDE asked them to wait until she could turn on the recorder. Then they could ask their questions and she would answer each one until the time ran out and then either the doctor or she would answer any questions remaining and mail the answers to them. The doctor turned to the parents after they left and said now I understand why you would not tell them. They would not have listened to you, but would have believed their friends.

The trip home was more peaceful. The son said he now remembered that the foods had changed and less processed foods were brought into the home, but they had been allowed a few. The oldest daughter remembered the walks that had increased to slow runs and then longer. She said that now she understood why they were never discouraged from joining in, but had not been forced to participate. The youngest daughter now knew she had been set up to receive the information and call the other two.

Yes, every family is different and needs thought in the method used to discuss a diagnosis with them. This blog discusses a study and what the people with diabetes feels his or her family thinks about their diabetes. This blog covers some useful tips for the person with diabetes and how to manage some situations. The final blog I offer is about some of the reasons loving family members can be the worst at assisting good diabetes management.

Hopefully, you have not had any of these problems with family members or if you have just been diagnosed, you will carefully consider how to handle the situation.

Classification and Diagnosis of Diabetes

It is interesting how the American Diabetes Association dodges the classifications for diabetes. So there is no doubt, I will quote what they have in print.

“The classification of diabetes includes four clinical classes:

1. Type 1 diabetes (results from β-cell destruction, usually leading to absolute insulin deficiency)

2. Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance)

3. Other specific types of diabetes due to other causes, e.g., genetic defects in β-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation)

4. Gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy that is not clearly overt diabetes)”

At least for two years is a row they have been consistent, if that counts for anything. I do find it absurd that they lump genetic defects together with other diseases of the pancreas and drug- or chemical-induced diabetes. Yet again, prediabetes is only listed as a risk for diabetes. It is no wonder physicians do not take prediabetes seriously and in general ignore it. With research showing that diabetes can be stopped during this stage and full diabetes prevented, one would think this should receive more attention – maybe even rating it as diabetes so that insurance would cover treatment as a preventive measure since it has been proven that prediabetes intervention does help in the prevention of full onset of diabetes.

This means that the ADA only looks to something they can diagnose as a disease and treat as being important. Again, there is no incentive to diagnosis and treat prediabetes because without ADA making this a classification, medical insurance will have no incentive to reimburse for treatment or medications to stop diabetes. Even with the Centers for Medicare and Medicaid Services (CMS) expanding into many prevention services, the ADA does not see this as a value. Their mantra seems to be: “let them get diabetes and then we will treat them.”

Even if they did not change anything from last year in their statement after the classifications. They continue to give doctors a blanket to hide under when a patient is incorrectly diagnosed. They have stated, “Some patients cannot be clearly classified as type 1 or type 2 diabetic. Clinical presentation and disease progression vary considerably in both types of diabetes. Occasionally, patients who otherwise have type 2 diabetes may present with ketoacidosis. Similarly, patients with type 1 diabetes may have a late onset and slow (but relentless) progression of disease despite having features of autoimmune disease. Such difficulties in diagnosis may occur in children, adolescents, and adults. The true diagnosis may become more obvious over time.”

Then in the diagnosis area, they also repeat the information from 2012. In one short paragraph, they throw out the oral glucose tolerance test (OGTT) and then bring it back later – at their convenience. They cite costs and later use the OGTT when it suits their needs. They recognize that African Americans may have higher rates of glycation and then dismiss this as controversial. They cite epidemiological studies for their dismissal and then leave out other studies that show that Asians may also have higher glycation rates.

It seems that the people in charge do what suits them and ignore what they don't want to consider. With the increase of Americans from other countries, more consideration needs to be paid to their ethnic heritage and variances from the European and Scandinavian heritage of most of them.